MEDICARE: OHIOGUIDESTONE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	I.0009197	OH
2	251S00000X	Community/Behavioral Health Agency	I.0009197	OH

General Provider Information

NPI Number	:	1114058674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIOGUIDESTONE

Provider Business Mailing Address
First Line	:	434 EASTLAND RD.
Second Line	:
City	:	BEREA
State	:	OH
Zip	:	44017-2058
Country	:	US
Telephone Number	:	440-260-8327
Fax Number	:	440-234-8319

Provider Business Practice Location Address
First Line	:	5706 TURNEY RD
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3971
Country	:	US
Telephone Number	:	440-260-6115
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DONNA KEEGAN
Credential	:
Telephone Number	:	440-260-8338

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/15/2017

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Directions to “OHIOGUIDESTONE ” Practice Location

Language	Start Address	Practice Location

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